Radiology Coding Alert

Hint: You don't always need modifier 62

Too often, the first physician's claim across the finish line wins reimbursement for procedures requiring more than one physician -- especially if another provider takes credit for radiology services. Use this quiz to hone your skills and make sure you get a clean radiology claim in to your payer quickly.

Try Your Hand at These Team Procedure Questions

Question 1: Do a radiologist and a speech language pathologist both need to be present for you to code a modified barium swallow procedure?

Question 2: A surgeon places a gastrostomy tube percutaneously without an endoscopic component.

You're coding for the radiologist who provided ultrasound or fluoroscopy as guidance. What CPT code(s) should you report?

Question 3: A physician performs a chest tube insertion for a patient diagnosed with a non-traumatic hemothorax. What CPT and ICD-9 codes should you report for a radiologist providing fluoroscopic guidance?

Question 4: In a AAA procedure, a surgeon performs bilateral femoral cutdowns, and you need to code for the interventional radiologist who places the catheters bilaterally into the aorta and performs radiological supervision and interpretation. Both physicians place the modular bifurcated prosthesis. What CPT codes should you report for the radiologist?

Are you a master at coding multiple-provider services? Find out below.

Answer 1: A radiologist and a speech language pathologist may both need to be present for you to code a modified barium swallow. "Professional guidelines recommend that the service be provided in a team setting with a physician/NPP who provides supervision of the radiological examination and interpretation of medical conditions revealed in it," says the Medicare Benefit Policy Manual, chapter 15, section 230.3, page 148.

Translation: By using the word recommend instead of require, CMS leaves the real decision-making up to individual states and payers that may choose to go stricter.

If your state or payer decides to take a firmer stance on the supervision issue, you must follow its law first. For example, our state board requires that the physician be the one actually pushing the fluoro, says Kathryn Hammond, MS, CCC, a practicing speech-language pathologist (SLP) at Havasu Regional Medical Center in Lake Havasu City, Ariz.

Remember: If you are coding only for the radiologist's portion of the exam, coordinate to determinate who is coding which procedure. Example: The SLP may report 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) while you report 74230 (Swallowing function, with cineradiography/videoradiography) for the radiologist's services.

Answer 2: When a radiologist provides guidance for percutaneous gastrostomy tube placement, report 74350 (Percutaneous placement of gastrostomy tube, radiological supervision and interpretation).

The surgeon will report 43750 (Percutaneous placement of gastrostomy tube).

During this procedure, the surgeon punctures the abdominal wall from outside the body and inserts a device under fluoroscopic or ultrasound guidance. This allows the surgeon to pull the stomach up to the abdominal wall. The surgeon then inserts the tube percutaneously without using an endoscope, says Joshua T. Rubin, MD, with the University of Pittsburgh Medical Center.

Caution: If the radiologist simply reads the films and is not present for the procedure, add modifiers 52 (Reduced services) and 26 (Professional component) to the S&I code (74350-26-52). This tells the carrier that the physician supervised or interpreted the exam but did not do both. In this situation, the surgeon should report the same code (74350-26-52) to indicate that he supervised -- but did not interpret -- the imaging portion of the procedure.

Answer 3: To report the radiologist's fluoroscopy when another physician inserts a chest tube, you typically report 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation).

The other physician will report 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]).

You should link 75989 to ICD-9 code 511.8 (Other specified forms of effusion, except tuberculous), which includes a note that the code covers hemothorax.

Answer 4: Report the radiologist's work in this team AAA with:

• 36200 (Introduction of catheter, aorta) and append modifier 50 (Bilateral procedure)
• 34802 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [one docking limb]) and append 62 (Two surgeons) to acknowledge both surgeons
• 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation) and append 26 (Professional component) if you need to alert the payer that the radiologist only provided the professional component of the service.

Tip: You should only report the RS&I code once per AAA procedure, says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.

The surgeon should report:

• 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral) and append modifier 50
• 34802-62.

Protect yourself: Make sure that both physicians report the two-surgeon service with the same code and that both append modifier 62. Not doing so can lead to denials and reimbursement delay